Today, a person who is healthy and constantly modifying his or her disease risk factors, is at an unfair disadvantage in the health insurance arena. Because that individual's healthy lifestyle frequently places him or her above the typical person, the high positive health rating effectively subsidizes someone else who goes through life with multiple disease risk factors, and does nothing to modify them. In effect, therefore, the healthy individual is penalized. For the employer, this penalty translates into money. That is, the employer, who encourages its employees to be healthy, will nonetheless be penalized for those who are not. In addition, that employer, when assessing potential future costs for health insurance for a pool of employees, has absolutely no basis to evaluate that pool's collective risks from a health insurance standpoint.
Presently, no systems exist which focus on an average person's health risks and then provide that person with an incentive to modify them. Moreover, no system exists which aids the employer and the insurer in determining insurance costs by providing a financial evaluation that reflects the impact of chosen lifestyles on health insurance premiums. Additionally, existing insurance valuation systems are too narrowly focused on existing diseases and thus fail to account for potential diseases that could likely occur in an individual who has multiple risk factors.
For example, U.S. Pat. No. 4,975,840 to DeTore et al., discloses a risk evaluation system for life insurance where computer software automatically provides evaluation data for policy classification. To accomplish this goal, DeTore et al. relies on an underwriting knowledge database which is addressed by a computer in conjunction with an application database. Both databases store problem issues and assign weights to those issues which result in a subsequent risk classification. The assigned weights, in effect, reflect debits/credits for an insurance policy.
However, DeTore et al. only focus on evaluating existing medical problems. It lacks any capability for assessing lifestyle data. In addition, De Tore et al. does not perform a determination pertinent to health insurance coverage, only to life insurance. Accordingly, the DeTore system fails to effectively assess an individual's “lifestyle” in order to attribute lifestyle factors to insurance valuation. It also fails to provide a basis for determining the effect of lifestyle choices on health insurance coverage.
U.S. Pat. No. 4,831,526 to Luchs et al. addresses the need for a system that automates the task of insurance quotation through a system which prepares and writes insurance contracts based upon data provided from clients. Unlike DeTore et al., Luchs et al. involves automating the entire insurance process, i.e., taking the application form, evaluating the application, and developing an insurance coverage based upon the risk assessments performed by the computer. However, Luchs et al. is solely directed to home insurance evaluation. As a consequence, Luchs et al. fail to address the problem of insuring an individual's health based upon an individual's lifestyle issues. There is no consideration for the factors which affect healthy risks that are unique to an individual's health.
Finally, U.S. Pat. No. 4,837,693 to Schotz relates to a system which enables employers to gather employee information in order to administer and implement a group insurance plan. Schotz relies on a computer system which automatically converts group insurance coverage into individual term contracts. The computer system also allows an insurer to readily underwrite the insurance plan. Schotz includes a database of employee census data which includes, among other things, an employee's name, hiring date, age, birth date, salary, status, and sex. Schotz, however, is solely directed to providing insurance risk adjustments for life insurance. As a consequence, Schotz can not assess an employee's lifestyle or health insurance risk based upon lifestyle choices. In addition, Schotz fails to address the need for a system which is directed to assessing health insurance coverage particularized to the individual risk assessments derived from an individual's lifestyles.
In sum, there are many types of potentially insurable health-related risks that range from cancer, heart disease, medical tests, obesity, environmental sources, etc. Individuals and companies, therefore, desperately need a means by which they can assess these risks and provide a basis for improving both an individual's health, determine his health risks and assess the overall liability of the employer for such health risks.